Kanuka honey versus aciclovir for the topical treatment of herpes simplex labialis: a randomised controlled trial

BMJ Open. 2019 May 14;9(5):e026201. doi: 10.1136/bmjopen-2018-026201.


Objective: To compare New Zealand medical grade kanuka honey with topical aciclovir for the treatment of herpes simplex labialis.

Design: Prospective parallel randomised controlled open-label superiority trial.

Setting: 76 community pharmacies across New Zealand between 10 September 2015 and 13 December 2017.

Participants: 952 adults randomised within the first 72 hours of a herpes simplex labialis episode.

Interventions: Random assignment 1:1 to either 5% aciclovir cream or medical grade kanuka honey (90%)/glycerine (10%) cream, both applied five times daily.

Outcome measures: The primary outcome was time from randomisation to return to normal skin (stage 7). Secondary outcomes included time from randomisation to stage 4 (open wound), time from stage 4 to 7, maximal pain, time to pain resolution and treatment acceptability.

Results: Primary outcome variable: Kaplan-Meier-based estimates (95% CI) for the median time in days for return to normal skin were 8 (8 to 9) days for aciclovir and 9 (8 to 9) for honey; HR (95% CI) 1.06 (0.92 to 1.22), p=0.56. There were no statistically significant differences between treatments for all secondary outcome variables. No related serious adverse events were reported.

Conclusion: There was no evidence of a difference in efficacy between topical medical grade kanuka honey and 5% aciclovir in the pharmacy-based treatment of herpes simplex labialis.

Trial registration number: ACTRN12615000648527;Post-results.

Keywords: aciclovir; cold sore; herpes simplex labialis; kanuka honey; pragmatic trial; randomised controlled trial.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acyclovir / administration & dosage*
  • Adult
  • Antiviral Agents / administration & dosage*
  • Female
  • Herpes Labialis / drug therapy*
  • Honey*
  • Humans
  • Kunzea
  • Male
  • Middle Aged
  • New Zealand
  • Pharmacies / statistics & numerical data
  • Prospective Studies
  • Wound Healing / drug effects


  • Antiviral Agents
  • Acyclovir

Associated data

  • ANZCTR/ACTRN12615000648527